# Safety Profile of Intraoperative Corneal Debridement in Descemet Membrane Endothelial Keratoplasty (DMEK)—A Retrospective Comparative Study

## TL;DR

This study examines whether cleaning the cornea during a specific eye surgery affects recovery outcomes, finding that it may not harm long-term results when other factors are considered.

## Contribution

The study provides new evidence that intraoperative corneal debridement in DMEK does not significantly impact graft survival when adjusting for confounding factors.

## Key findings

- Bivariate analyses showed worse postoperative outcomes in debridement cases.
- Multifactorial regression found no significant effect of debridement on graft survival.
- Fuchs’ endothelial dystrophy was associated with lower graft failure risk.

## Abstract

To investigate the influence of intraoperative corneal debridement on postoperative outcomes in Descemet Membrane Endothelial Keratoplasty (DMEK).

This retrospective comparative study analyzed 3168 eyes that underwent DMEK between 2012 and 2024. Intraoperative corneal debridement was performed in 215 eyes (6.8%) to improve visualization during the procedure. Survival time analyses with Kaplan–Meier curves and log‐rank test and multifactorial Cox regression were conducted to assess the impact of corneal debridement on postoperative graft survival.

Bivariate survival analyses suggested that intraoperative corneal debridement during DMEK may be associated with worse postoperative outcomes in terms of visual acuity, endothelial cell density, graft survival, and perioperative complications. Using the log‐rank test, significant differences were observed in endothelial cell density, postoperative regrafting, and visual acuity (p < 0.005), while the need for rebubbling was not statistically significant (p = 0.5). However, multifactorial Cox regression analysis, controlling for potential confounding factors, revealed that the difference in hazard ratios between the debridement and no‐debridement groups had no statistically significant effect on graft survival (HR = 0.74, 95% CI: 0.49–1.11, p = 0.141). Patients with Fuchs’ endothelial dystrophy had a significantly lower risk of graft failure compared to other indications (HR 0.41, p < 0.001).

In bivariate analyses, intraoperative corneal debridement was associated with worse postoperative outcomes, including reduced visual acuity, endothelial cell density, and graft survival. However, these differences likely reflect the more severe cases in the debridement group. When adjusting for potential confounders, multifactorial Cox regression analysis showed that corneal debridement did not have a significant impact on graft survival. This suggests that while debridement may be associated with poorer outcomes in unadjusted analyses, it does not appear to adversely affect graft survival when accounting for other factors. Corneal debridement may therefore be a safe and viable option in DMEK, though further research is needed to confirm its impact on long‐term outcomes.